Safe and Easy Method to Prevent Bile Leakage in Biliary Reconstruction: Placing a Double J Catheter

Bile leak remains an important complication after biliary reconstruction, particularly in living donor liver transplant. We evaluated the effect of routine intraoperative placement of a double J stent across the biliary anastomosis on postoperative bile leak in patients undergoing biliary reconstruction.

This retrospective cohort study included 63 patients who underwent biliary reconstruction with intraoperative double J stent placement at Başkent University Hospital between November 2021 and January 2025. Fifty-five patients were liver transplant recipients, and 8 patients underwent hepatopancreatobiliary surgery for tumor resection, trauma, or complex benign biliary disease. We analyzed demographic characteristics, biliary anatomy, number of bile ducts, type and number of biliary anastomoses, and postoperative biliary complications.

Of 63 patients, 35 were male and 28 were female. Among the liver transplant recipients, 51 underwent living donor liver transplant and 4 underwent auxiliary liver transplant; 30 were pediatric and 25 were adult recipients. Duct-to-duct anastomosis was the most commonly used reconstruction technique, followed by Roux-en-Y hepaticojejunostomy and hepaticoduodenostomy. Multiple bile ducts were present in 17 patients. Early bile leak developed in 6 of 63 patients (9.52% ). Among living donor liver transplant recipients, bile leak occurred in 5 of 51 patients (9.8% ). All patients with bile leak had more than 1 bile duct. Four patients were managed endoscopically with stent removal, sphincterotomy, and internal biliary stent placement, and 2 patients underwent percutaneous drainage. No patient required reoperation, and no mortality related to bile leak was observed. No clinically significant stent migration, severe cholangitis, or stent-related obstruction developed during follow-up.

Intraoperative placement of a double J stent during biliary reconstruction appears to be a safe and practical adjunct in both liver transplant and complex hepatopancreatobiliary surgery, particularly in patients with multiple bile ducts. Prospective controlled studies are needed to better define its role.